比較自來水與生理食鹽水對傷口的清潔：利用AMSTAR綜觀系統性文獻回顧

Background: Numerous solutions such as tap water and sterile saline are available for wound cleansing, yet the evidence of these interventions is complex across the literature. Purpose: We aimed to compare the difference between tap water and saline for wound cleansing through an overview of systematic reviews. Methods: MEDLINE, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews were searched on Oct. 2016. Systematic reviews that examined adults receiving care for their wound cleansing were included. Two reviewers independently screened the literature, abstracted data, and assessed study quality using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. Results: Seven systematic reviews were included after screening and 4 were systematic reviews without a meta-analysis. Overall, 42.86% of included reviews were rated as being of high quality (AMSTAR score ≥8). For the pressure ulcers, two studies reported no statistically significant change in healing was seen when wounds were cleaned with water was compared with saline. For the chronic wounds, two studies showed there was no increase in infection or in wound healing rates between patients whose wounds were cleaned with tap water or sterile saline. Finally, 4 of studies presented that the use of tap water to cleanse acute wounds in adults and children was not associated with a statistically significant difference in infection rate when compared to saline. Conclusion / Implications for Practice: The high quality evidence indicates that using tap water to cleanse acute, chronic or pressure wounds are no significant difference increases or reduces infection when compared to saline. The AMSTAR scale can useful to evaluate the quality of systematic reviews. However, most studies were consistently across all outcomes throughout the literature. Clinicians and nurses rarely use the results to wound cleansing. The gap between what we know and what we do remains a challenge for the discipline and the professions. Evidence-based medicine has emphasized the fact that often decisions are value and partiality sensitive. To do the best for the individual patient, clinicians need to evaluate patients' values and preferences, especially of shared decision-making.